While outpatient surgery
providers often are fierce competitors, some providers are finding multiple
advantages in sharing equipment, supplies, and even names of potential employees
with each other.

Here’s some of the strategies
that have paid off for same-day surgery providers:

Sharing information.

Sharing information in
a variety of areas can be very helpful when opening new outpatient surgery programs,
says Deborah T. Womble, RN, CNOR, administrator at Children’s West Surgery
Center in Knoxville, TN. Another surgery center in Knoxville allowed the business
office manager and the nurse manager from Children’s West to visit for several
days. "They shared forms, inventory lists, etc.," she says. "The nurse manager
from this facility would call me every time she would think of something that
had been a problem for them in the upstart."

Additionally, Womble and
her nurse manager visited another pediatric-specific surgery center in Memphis,
TN, one of only 10 in the world. "We spent the day with the nurse manager touring
her facility and asking questions of any staff members," Womble says. "That
was a wonderful experience. We didn’t feel so alone then."

The nurse manager shared
forms with Womble. "We discussed things they had tried and failed as well as
those that were successful for them," she adds.

Womble has obtained information
through other networking resources including the member directory of the Federated
ambulatory Surgery Association (FASA) in Alexandria, VA. She surveyed FASA members
concerning anesthesia criteria specific to pediatric population and received
a good response, Womble explains.

Other networking opportunities
have come through a chat group of perioperative nurses who belong to the Association
of periOperative Registered Nurses (AORN) and e-mails obtained at national surgery
conferences. Additionally, she is forming a support group of area surgery center
administrators and nurse managers.

Mount Nittany Surgical
Center in State College, PA, is on friendly terms with its community hospital,
says Roger Pence, administrative director of Mount Nittany and president
of FWI Healthcare, an Edgarton, OH-based consulting firm for primarily ambulatory
health care providers. Originally, the not-for-profit hospital sponsored the
formation of the not-for-profit ASC. Several members of the hospital board also
serve on the surgery center’s board.

"During capital budgeting
time, we share information on equipment/instruments each may be purchasing so
that we both buy the same manufacturer, model, or style," Pence says. "This
way, we don’t end up with a [lemon] no one will use or have problems in getting
it serviced."

Also, the surgeons who
work in both settings have the opportunity to use familiar equipment in both
places. And when clinical staff are hired from the hospital, they already have
used the same style and type of equipment, he says. "This, in turn, enables
their orientation to be rapid and proficient," Pence explains.

Many of the items that
the hospital and ASC share information on are high-volume usage such as scopes
and drills. For other items, the center’s managers determine the expected volume
of procedures to justify the purchase of equipment.

Sharing names of
potential employees.

Initially, Womble called
a nurse manager at another ASC to ask whether she would consider being a nurse
manager at Womble’s facility.

"She was happy where she
was, but recommended a staff nurse who was working part time at two facilities,"
she says.

That nurse was hired and
has been with the ASC for 1½ years, Womble adds.

Sharing equipment
and supplies.

Even when a hospital’s
managers are adamantly against the formation of a surgery center, many of the
hospital’s departments eventually may work out verbal or written agreements
to help the ASC, Pence advises. For example, an ASC, with its low-volume usage
of expiring drugs, can trade these drugs to the hospital where there is a higher
volume usage.

"Occasionally, when certain
surgical supply items unexplainably are not in inventory, a call to the local
hospital by the ASC usually will result in the ability to borrow stock until
delivery is made," Pence says. Also, ASCs may be able to rent floor polishers
and other infrequently used items from their local hospitals, he adds.

"When there is a positive
working relationship with the local hospital, the ASC even has greater benefits
in this area," Pence notes.

Womble’s facility, four
other surgery centers, and a nearby hospital help each other when they need
instruments, sutures, or other supplies.

"If they have a pediatric
need, we can usually be helpful to them," Womble says. "They can help us with
general things."

While some providers may
be wary of loaning expensive instruments, Womble says her experience has been
positive.

"So far, we have been very
fortunate that the facilities have taken very good care of our instruments,
and we have [taken very good care of] theirs,’ she says. " If we started having
problems with care of our instruments or not prompt return, this would be a
problem."

Sometimes, Children’s West
allows a surgeon investor to use instruments at another facility. In some cases,
the borrowing surgeons are ones who Womble would like to have as investors.
"Kindness goes a long way for many things," she says.

If you are providing equipment
or supplies to another organization at less then fair-market value, consult
with your legal advisor to ensure you aren’t violating any laws or tax codes,
legal experts advise.

For example, if a tax-exempt
entity is involved, the question, at a minimum, raises private inurement and
private benefit issues, explains Eric Zimmerman, JD, partner with McDermott
Will & Emery in Washington, DC.

"In addition, if any of
the users are persons with substantial influence over the affairs of the tax-exempt
entity — such as medical directors or, perhaps, large referral sources — then
intermediate sanctions issues under Section 4958 of the Internal Revenue Code
also arise," he points out. "Further, if any of the facilities or equipment
are financed with the proceeds of a tax-exempt bond offering, the analysis becomes
even more complex."

In addition, the Stark
Law and fraud and abuse laws may be applicable, Zimmerman says.

Selling equipment.

Womble’s facility and other
local surgery center have purchased instrument sets from each other. "The sets
and/or equipment we sold to each other was sold at our original cost," she says.
"I discounted a liposuction unit $1,000 so we could borrow it."

Having collaborations with
area providers offers multiple advantages, Womble adds.

"I believe these types
of relationships are critical to the quality of patient care we provide," she
notes. "I have never denied any facility anything it needed for a patient. We
all can’t have everything we need and must help each other."

Sources

For more information on
collaborations among same-day surgery providers, contact: